构建老年抑郁症患者继发轻度认知功能障碍的预测模型及应用性分析

摘要

目的 基于当前临床诊疗技术,构建老年抑郁症继发轻度认知功能障碍(MCI)的预测模型,并进行应用性分析. 方法 连续性纳入三家三级精神病专科医院2013年9月至2015年12月收治的老年抑郁症患者为观察队列,搜集相关临床资料,对其进行为期18个月的随访以确认预后转归.依据随访结果预判继发MCI风险的影响性指标,并验证相关指标临界值对继发MCI时间窗的评判效能. 结果 最终纳入216例老年抑郁症患者,其中累计9例患者失访,最终27例患者继发MCI,180例患者于随访期内认知功能正常.Cox回归多变量分析显示,老年抑郁症患者继发MCI的风险模型由年龄(HR:1.30,95％CI:1.12～1.64,P=0.03)、受教育年限(HR:0.56,95％CI:0.41～0.80,P=0.01)、规律接受团体心理治疗(HR:0.73,95％CI:0.58～0.92,P=0.03)、BeckSrivsstava压力量表(BSSI)量表分(HR:1.24,95％CI:1.08～1.56,P=0.03)组成,其中年龄、BSSI量表为危险性因素,受教育年限、规律接受团体心理治疗为保护性因素;年龄≥72.3岁、受教育年限＜8.3年、BSSI量表≥75.1分的老年抑郁症患者,继发MCI的时间窗更短,上述独立影响因素的临界值具有显著评判效能. 结论 年龄、受教育年限、规律接受团体心理治疗、BSSI量表是老年抑郁症治疗的患者继发MCI的独立影响因素,且年龄≥72.3岁、受教育年限＜8.3年、BSSI量表≥75.1分为该患者群体继发MCI的评判临界点.%Objective To build a predictive model of depression with secondary mild cognitive impairment (MCI) in elderly patients based on current clinical diagnosis and treatment technology,and to analyze its application.Methods Elderly patients with depression hospitalized in three hospitals were consecutively included in our study from September 2013 to December 2015 for collecting relevant clinical data,and followed up for 18 months to confirm a prognosis.The follow-up results were used to predict influencing indices for secondary MCI risk,and to verify judgement effectiveness of the critical value of the relevant indices on the window of time of the secondary MCI.Results A total of 216 elderly patients with depression were included in this study,of whom 9 patients were lost to follow-up.Finally,27 patients had secondary MCI,and 180 patients had normal cognitive function during the follow-up period.Cox multiple regression analysis showed that the risk model of secondary MCI in elderly patients with depression was composed of age (HR:1.30,95 ％ CI:1.12-1.64,P =0.03),education years (HR:0.56,95 ％ CI:0.41-0.80,P =0.01),regular psychological treatment (HR:0.73,95％ CI:0.58-0.92,P=0.03),and BSSI scale (HR:1.24,95％ CI:1.08-1.56,P=0.03).Age and BSSI scale were risk factors,while education years and regular group psychotherapy were protective factors.For an elderly patient with depression who was characterized by age ≥ 72.3 years,education years ＜8.3 years,and BSSI scale ≥75.1,the window of time for secondary MCI was shorter,and these critical values of the independent factors had significant judgement effectiveness.Conclusions Age,education years,regular psychological treatment,and BSSI scale are independently influencing factors for secondary MCI in elderly patients receiving the treatment for depression.Furthermore,age ≥72.3 years,the education period ＜8.3 years,and BSSI scale ≥75.1 points are critical values of secondary MCI.